Parkinson’s disease has been one of the most interesting conditions mentioned in the news lately, with much exciting research and the prominent case of Michael J. Fox bringing international attention to this ancient malady. Although Fox was only 36 when he announced he was suffering from the debilitating disease, Parkinson’s is generally an affliction of the elderly, usually occurring in people in their 50s or older. Other prominent Americans who have acknowledged being treated for Parkinson’s include Janet Reno and Muhammad Ali.

Parkinson’s disease is named after Dr. James Parkinson who first described it in 1817, though the “shaking palsy” has surely existed since time immemorial. This disease is a slowly progressive condition characterized mainly by tremors of the limbs, stiffness and rigidity of the muscles, slowness of movement, and a stooped posture with difficulty in balance and walking. The face is often described as expressionless and “mask-like." The diagnosis is based on the presence of these symptoms as there is no other specific test for the disease. Other symptoms can include difficulty with speaking and swallowing, low blood pressure, sleeping difficulty and depression. Mental deterioration similar to Alzheimer’s also occurs in about half of patients with Parkinson's. Unfortunately the condition is progressive and can lead to severe disability.

The cause of Parkinson’s disease is unknown but seems to involve a deterioration of certain parts of the brain called the basal ganglia and a resulting imbalance of certain neurotransmitter chemicals in the brain, particularly a chemical called dopamine. The disease can last for many years and may end up so severe that the unfortunate individual can barely move or speak, although it is not always that bad. But it is common (one percent of people over 60) and serious enough that researchers are making intensive efforts to treat and cure the disease. Parkinson’s-like symptoms can also occur with other brain diseases and can be a side effect of certain medications, so it is important to get a thorough medical history and physical to make certain of the correct diagnosis.

Smoking has been found to increase the risk of Parkinson’s disease, and drinking coffee and other caffeinated beverages seems to decrease the risk. So, coffee drinkers enjoy! A 2003 study also suggested that regular use of “non-steroidal anti-inflammatory drugs” such as Motrin seems to reduce or delay the onset of Parkinson’s. Previous studies indicated these drugs may also reduce the risk of Alzheimer’s disease. Doctors would not recommend taking these drugs just for the purpose of avoiding Parkinson's or Alzheimer's but if you are taking them for arthritis this may be an extra benefit.

There is still no definite cure or prevention for Parkinson’s, but medication often helps people control the symptoms and lead relatively normal lives. And there is much optimism about even better treatments and cures in the future.

Since the 1950’s, scientists have known that in Parkinson’s there is a particular deficiency of the brain chemical dopamine, which can be partially replaced using the drug levodopa or Sinemet, which stimulates more dopamine in the brain. This medication often helps patients tremendously but its effects often fluctuate or wear off in a few years.

Many other new medications have been developed -- several in just the last few years -- which act in different ways on the dopamine system. Many patients are now started on these “dopamine agonist” medications such as Requip and Mirapex, before or along with levodopa in the hopes of improving and prolonging the response to the medication.

In addition to medications, physical therapy is often prescribed to help the patient maintain mobility and function.

Finally, the hottest development is brain surgery for Parkinson’s When drugs alone aren’t enough to control the tremors and rigidity, doctors have found that surgery on certain areas of the brain (thalamotomy and palidotomy) and deep brain stimulation with electrodes can control the damaged areas. In addition, there is much hope for stem cell research to ultimately replace the damaged cells and completely cure Parkinson’s as well as other degenerative brain diseases such as Alzheimer’s.

More information and support for Parkinson’s victims and their families is available from the American Parkinson's Disease Association, 1-800-223-2732 and the Parkinson's Disease Foundation, 1-800-457-6676. There are also local support groups available.

Dr. Todd Goldberg is Director of the Geriatrics Fellowship Program at Albert Einstein Medical Center and Assistant Professor of Medicine, Thomas Jefferson University. For more information on Albert Einstein Healthcare Network and its programs and services for seniors, call 1-800-EINSTEIN.

This article originally appeared in the Jan. 29, 2004 edition of the Jewish Exponent.